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Current practice for determining pulmonary capillary wedge pressure predisposes to serious errors in the classification of patients with pulmonary hypertension.
MedLine Citation:
PMID:  22520524     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Accurate measurement of left ventricular filling pressure is important to distinguish between category 1 pulmonary arterial hypertension (PAH) and category 2 pulmonary hypertension (PH) from left heart diseases (PH-HFpEF). We hypothesized that the common practice of relying on the digitized mean pulmonary capillary wedge pressure (PCWP-digital) results in erroneous recordings, whereas end-expiratory PCWP measurements (PCWP-end Exp) provide a reliable surrogate measurement for end-expiratory left ventricular end-diastolic pressure (LVEDP-end Exp-end Exp).
METHODS: We prospectively performed left and right cardiac catheterization on 61 patients referred for evaluation of PH and compared the LVEDP-end Exp to end-expiration to the (a) PCWP-end Exp and (b) PCWP-digital.
RESULTS: The PCWP-end Exp was a more reliable reflection of LVEDP-end Exp (mean 13.2 mm Hg vs 12.4 mm Hg; P, nonsignificant) than PCWP-digital (mean 8.0 mm Hg vs 12.4 mm Hg, P < .05). Bland-Altman analysis of PCWP-digital and LVEDP-end Exp revealed a mean bias of -4.4 mm Hg with 95% limits of agreement of -11.3 to 2.5 mm Hg. Bland-Altman analysis of PCWP-end Exp and LVEDP-end Exp revealed a mean bias of 0.9 mm Hg with 95% limits of agreement of -5.2 to 6.9 mm Hg. If PCWP-digital were used to define LVEDP-end Exp, 14 (27%) of 52 patients would have been misclassified as having PAH rather than PH-HFpEF. Patients with obesity and hypoxia were particularly more likely to be misclassified as PAH instead of PH-HFpEF if PCWP-digital was used to define LVEDP-end Exp (odds ratio 8.1, 95% CI 1.644-40.04, P = .01).
CONCLUSIONS: The common practice of using PCWP-digital instead of PCWP-end Exp results in a significant underestimation of LVEDP-end Exp. In our study, this translated to nearly 30% of patients being misclassified as having PAH rather than PH from HFpEF.
John J Ryan; Jonathan D Rich; Thejasvi Thiruvoipati; Rajiv Swamy; Gene H Kim; Stuart Rich
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  163     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  589-94     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL.
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